Neonatal Outcome in Growth-Restricted Versus Appropriately Grown Preterm Infants

Abstract

The objective of this paper is to examine whether growth-restricted preterm infants have a different neonatal outcome than appropriately grown preterm infants. All consecutive, singleton preterm deliveries between 27-35 weeks' gestation were included over a 4-year period. Infants with congenital anomalies and infants of diabetic mothers were excluded. Infants were categorized as small-for-gestational-age (SGA) when birth weight was at or below the 10th percentile, and appropriate-for-gestational-age (AGA) when between the 11th and 90th percentiles. Outcome variables included: neonatal death, respiratory distress syndrome (RDS), sepsis, intraventricular hemorrhage (IVH), and necrotizing enterocolitis (NEC). Neonatal morbidity and mortality were examined by univariate and stepwise multivariate logistic regression analyses. Factors controlled for during the analysis included: maternal age; gestational age; mode of delivery; presence of preeclampsia, HELLP syndrome, prolonged premature rupture of membranes (PROM), placental abruption, placenta previa, prenatal steroid exposure, infant gender, and low Apgar score. Seventy-six infants were included in the SGA group and 209 in the AGA group. SGA infants had a higher mortality rate (p = 0.003). They also had more culture-proven sepsis episodes (p = 0.001). No differences were found with respect to the other outcomes. The results were similar when analyzed separately for the group of infants born at or below 32 weeks' gestation. Growth-restricted preterm infants were found to have both higher mortality and infection rates compared with AGA preterm infants. Growth restriction in the preterm neonate was not found to protect against other neonatal outcomes associated with prematurity. When considering elective preterm delivery for this high-risk group of pregnancies, the increased risks in the neonatal period should be taken into account.

Clinical Microbiology of Bacterial and Fungal Sepsis in Very-Low-Birth-Weight Infants

“…Infants who are SGA have been found to be at decreased risk for EONS (454) but at higher risk for LONS than their appropriately grown gestational age-matched peers (82,437). This may be because SGA infants are susceptible to neutropenia associated with maternal preeclampsia or because they may require central venous catheters and parenteral nutrition for long periods due to a predisposition to feeding intolerance and NEC.…”

Significance of Umbilical Artery Velocimetry in Perinatal Outcome of Growth Restricted Fetuses

“…24 Higher mortality rates are reported in those fetuses with absent or reversed end-diastolic flow on antenatal doppler velocimetry which is similar with present result. 25,26 In this study it was found that still birth and IUD (Intrauterine death) was 4(8%) and neonatal death was 3(6%).…”

Intra‐uterine Growth Restriction Downregulates the Hepatic Toll Like Receptor‐4 Expression and Function

“…Both animal and human data suggest that IUGR increases the risk of sepsis and death from Gramnegative bacterial infections during the neonatal period (Simchen et al 2000). Lipopolysaccharide (LPS) is the main component of Gram-negative bacterial cell wall and is a potent inducer of the innate immune responses (Wenzel et al 1996, Rietschel et al 1996 through TLR4 (Poltorak et al 1998, Hoshino et al 1999.…”

“…Adverse factors that impair fetal growth such as maternal malnutrition, hinder immunological maturation as well (Moscatelli et al 1976, Chandra 1975a,b 1981, Ferguson 1978, Hasselbalch et al 1999. Both animal and human data suggest that those who are small for gestation show persistent immunological impairment for several months or even years (Chandra 1975c, Beach et al 1982, and that they are at increased risk of infections with Gram-negative bacteria during the neonatal period and childhood (Simchen et al 2000).…”